Individual
KACEY BLEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6267
(208) 381-4171
(208) 381-4172
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1214536
ID
363A00000X
Physician Assistant
Primary
PA-2652
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/19/2022
Last updated
01/17/2024
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